The Medical Model of Disability:
The Medical Model states that a person is ‘disabled’ as a result of their impairments or deficiencies, and that such impairments or deficiencies should be ‘fixed. Fundamentally, it is an approach which focuses on a person’s limitations or what is ‘wrong’ with them, rather than their needs.
The Social Model of Disability:
By contrast, the Social Model focuses on the systemic barriers, negative perceptions and exclusionary attitudes towards people living with disabilities, and argues that it is these, and not the characteristics of the person, which are the predominant 'disabler'. The Social Model is the contemporary paradigm through which ‘disability’ is viewed as it places responsibility on societies to be appropriately adaptive to the needs of people with disabilities, and thus reduce or eradicate disablements. This concept is supported by the World Health Organisation’s International Classification of Functioning, Disability and Health (WHO-ICF).
The World Health Organization's International Classification of Functioning, Disability and Health (ICF):
The ICF, in part, synthesises the Medical Model and the Social Model, and creates a Biopsychosocial Model of Disability. It acknowledges that a person may have ‘health conditions’ which impede functioning (drawing on the Medical Model), however it goes further to state that ‘environmental factors’ (such as social attitudes, legal and social structures) and ‘personal factors’ (such as personal characteristics, social background, age and gender) influence how ‘disabling’ a health condition may be (drawing from the Social Model).
To this end, the ICF supports the notion that a person is only ‘disabled’ when the social and physical constructs are not suited to meet the needs of a person’s health condition. This squarely places responsibility on societies and communities to ensure that any and all enabling features (from accessible transport to social attitudes) are created, thus reducing and eliminating disability.
Social Role Valorization (SRV):
You may have heard of the term ‘Social Role Valorization’ or SRV. SRV is used to describe how groups of people are given lower value or worth within communities because of certain characteristics. It arose from the disability advocacy movement as a way of describing how people with disabilities were undervalued as global citizens.
The devaluing of people with disabilities has been pervasive throughout history, and it has been acceptable to place people with disabilities into low-value social roles. This has contributed (or more accurately, directly caused) poor economic standing, poor educational attainment, poor employment outcomes and poor social citizenship for many people. Often, this undervaluing has had far more significant repercussions on a person’s life than the health or physical impairment ever did!
When a person is valued or holds a ‘socially valued role’, they are more likely to experience what academics call the ‘good things in life’: a home, security, to be appreciated, to be able to work or contribute to others, to have a positive reputation, to have a range of roles and relationships, to belong.
We can learn from what SRV offers us. When we recognise and appreciate the intrinsic value and worth of all people, including people who live with disabilities, we are enhancing the social image, esteem and most importantly, the competencies of people to allow for the attainment of goals, aspirations and ‘the good life’.
Definition of Disability:
Disability is defined as any continuing condition that restricts everyday activities.
However, drawing on the ICF, a disability is not a feature of a person but instead the result of society’s inability or unwillingness to adapt environments or approaches to a person’s health condition. Therefore, when considering a person to have a disability, it is the fact that that person has been (or continues to be) unable to enjoy full and proper freedoms to participate in everyday activities because of physical or social barriers. Our goal must always be to eradicate such barriers, and therefore eradicate disability.
So, where others may define ‘types of disability’, we will define ‘types of health or learning conditions’. The predominant categories of health or learning conditions which may restrict participation in everyday activities include physical, sensory, psychiatric, neurological, cognitive and intellectual. Many people have multiple health impairments.
A physical health impairment is the most common (following by intellectual and sensory) and generally refers to musculoskeletal, circulatory, respiratory and nervous systems.
Sensory health impairments involves some kind of impairment of any of the senses: sight, hearing, smell, touch, taste or spatial awareness.
Neurological and cognitive health or learning impairments may involve a person's difficulties in remembering, learning new things, concentrating, making decisions in their everyday life, regulating mood or emotion, . Such impairments may be genetic, hereditary or acquired (e.g. through traumatic brain injury).
Intellectual health or learning impairments includes intellectual and developmental issues which relate to difficulties with thought processes, learning, communicating, remembering information and using it appropriately, making judgments and problem solving.
Mental health includes our emotional, psychological and social well-being. Decline in mental health may be brought about by biological factors (such as genetics or heredity) or life experiences (such as trauma and abuse).
Most, if not all people experience some time of restriction on their ability to undertake a task or action as a result of a health impairment – a person with diabetes should not consume sugar; a person who wears glasses has some form of sensory (visual) impairment; a person may be uncomfortable in large crowds or with meeting new people; a person may have a migraine and be unable to leave the house for a day. The key difference however, is that these are not seen by society as being ‘disabilities’ and they have not been cause for the lowering of social value or worth, which is a predominant chronic disabler for people with some types health or learning impairments.
The UN Convention on the Rights of Persons with Disabilities (CRPD):
The UN CRPD was adopted by the United Nations General Assembly on 13th December 2006, and was the first comprehensive human rights treaty of the 21st Century. It was borne out of a commitment undertaken by the United Nations to change attitudes and approaches to people with disabilities from being viewed as ‘objects of charity, medical treatment and social protection’ towards being viewed as people with "...rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent."
The convention reaffirms that all people with disabilities must enjoy all human rights and fundamental freedoms, and sets out protections (legal and otherwise) to ensure that such rights and freedoms are upheld.
The CRPD includes 50 Articles underpinned by 8 guiding principles. These principles are:
- Respect for inherent dignity, individual autonomy including the freedom to make one's own choices, and independence of persons
- Full and effective participation and inclusion in society
- Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity
- Equality of opportunity
- Equality between men and women
- Respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities
The CRPD was the catalyst to the development and implementation of wide-ranging political, legal and social reforms throughout the world. The 160 countries around the world who are signatories to the Convention have signed a legal undertaking that they will abide by the Articles within the Convention. As a result, most countries now have repealed legislation which directly or indirectly discriminated against people with disabilities, and have developed and implemented legislation, regulation and policies which ensure compliance with the Convention, including expansion of anti-discrimination legislation to capture people with disabilities.
Importantly, the Convention, while not defining ‘disability’, does set out the contemporary notion of ‘disability’ consistent with the International Classification of Functioning, Disability and Health (see our page on the ICF here [HYPERLINK]). The Convention (Article 2) states "...that disability is an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others." By providing this concept, the Convention places responsibility for the ‘enabling’ of people squarely on societies and communities, and removes the notion that people are to be characterised by their disability.
Read more about the CRPD here: (https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html)
When reading through the titles given to various pieces of historic legislation in any country, the evolution of language as it pertains to people with disabilities becomes evident. The use of demeaning terminology when referring to people with disabilities was commonplace, and it is only since the 1990s that respectful and empowering language has become the norm, and indeed expected.
Derogatory terms regarding people with disabilities are unacceptable, in the same way as we disapprove of derogatory terms based on people’s gender, ethnicity, age or religious beliefs. We should continue to be mindful of the vernacular we use every day which people with disabilities, and society, considers inappropriate. Below are some examples of how to avoid using outdated terms:
- Just say person!! Avoid characterising or placing labels on people: a simple way of doing this is to avoid the use of ‘a’ or ‘an’ before a noun – for example, don’t say ‘an epileptic’, ‘an intellectually disabled person’, ‘a haemophiliac’, and instead (if it’s relevant to state the person’s disability at all!) use ‘a person with epilepsy’, a person with an intellectual disability’, ‘a person with haemophilia’. This may seem trivial, but it’s in fact important. To say ‘a disabled person’ instead of ‘a person with a disability’ classifies or labels the person by their disability instead of recognising that a person is a person first.
- In most cases, referring to a person’s abilities or disabilities is completely irrelevant and unnecessary. A person who lives with a disability is no different; is not ‘special; does not need or want pity or sympathy; does not ‘suffer’ from a disability; is not brave because of their disability. Such terms can be patronising. To develop a society which is inclusive means that we must not be exclusive;
- Use language which is strengths-based, and not deficit-based. Focus on what a person CAN do, not what a person CAN’T do. Avoid terms like ‘defect’ or ‘deficiency’ or ‘disadvantaged’ – in addition to being inaccurate, this is deficit-based language.
- ‘Care’ versus ‘support’. To ‘care’ for someone implies a power imbalance – that the person being cared for is incapable. While the intentions of saying this are generally well meaning, to say that a person with disabilities needs to be ‘cared for’ is inaccurate, patronising and borrowed from the Medical Model. To say that a person with disabilities may require ‘support’ is, on the other hand, accurate and is strengths-based. It recognises that a person can be supported to achieve their goals and aspirations.
- ‘Programs’ versus ‘services’. Many organisations operate what they call ‘programs’ to support people living with disabilities. This is still a common term – however, programs are used to ‘program’ people, to fix them. Again, this is terminology borrowed from the Medical Model. A service offered to people with disabilities is no different to all other services we receive in daily life: transport services, telephone services, post office services – they are not called transport programs, telephone programs, post office programs.
- ‘To’ versus ‘for’ versus ‘with’. Historically, people with disabilities have had things done ‘to’ them, not ‘for’ them, and certainly not ‘with’ them. During the 1980s, this paradigm shifted and the vernacular changed towards providing services for people with disabilities. More recently, this has evolved yet again with the advent of such initiatives as the Personalisation reforms in the UK and the National Disability Insurance Scheme in Australia. Today, best practice service is based on designing and delivering services with people with disabilities – acknowledging that people are the experts in their own lives and as such should be empowered to lead the development of supports and services which affect them.